title: High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort.
abstract: OBJECTIVE
  Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population.
  
  
  RESULTS
  High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events.
  
  
  CONCLUSIONS
  Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.
authors.affiliation: Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.forename: Hugh
authors.initials: H
authors.lastname: Tunstall-Pedoe
authors.forename: Olli
authors.initials: O
authors.lastname: Saarela
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.forename: Tarja
authors.initials: T
authors.lastname: Tuovinen
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Allan
authors.initials: A
authors.lastname: Struthers
authors.forename: Maria
authors.initials: M
authors.lastname: Hughes
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D015995:Prevalence; D018570:Risk Assessment; D012606:Scotland / Q000453:epidemiology; D017678:Sex Distribution; D020521:Stroke / Q000097:blood / Q000401:mortality; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Cardiovascular risk; High-sensitivity assayed troponin I; MONICA Risk Genetics Archiving and Monograph (MORGAM); Mortality; Scottish Heart Health Extended Cohort (SHHEC)